Ali Forney puts premium on youth HIV testing

Volume 1, Number 53 | The Weekly Newspaper of Chelsea | September 21 - 27, 2007

Chelsea Now photo by Jefferson Siegel

Left to right: The Ali Forney Center’s Carl Siciliano (executive director), Eric Hartman (director of supportive services) and Steven Gordon (HIV services coordinator) share a laugh at the organization’s Chelsea/Hell’s Kitchen drop-in center on Tuesday.

By Chris Lombardi

Ali Forney Center’s Chelsea drop-in center is in a long, narrow office space, with cheerfully painted rooms to one side and crowded bulletin boards. Last Tuesday, though, the space seemed oddly clear of the queer youth the agency is built to serve.

“Where is everybody?” asked Carl Siciliano, the center’s founder and executive director, as one single, tall, slender youth of indeterminate gender slid by, with a dark bob and pink-framed sunglasses.

“I think they’re all watching Dreamgirls,” said outreach counselor Steven Gordon, chuckling at their motley crew all pressing into a room to watch Beyoncé Knowles. “These days,,” added Gordon, “I don’t know what homosexuality would be without Beyoncé.”

Gordon and Siciliano, of course, know full well that being gay extends further than popular culture. At the Ali Forney Center, which has grown in the past five years to become the largest agency in New York City serving exclusively formerly homeless LGBTQ youth, staff contend simultaneously with their clients’ need for health care, shelter, mental health, safety and HIV services.

On Tuesday, in the wake of statistics released last week that indicated a dramatic rise in HIV infection among young gay men in New York City, Chelsea Now sat down with Siciliano, Gordon and Program Director Eric Hartman at the drop-in center, half a mile from the agency’s headquarters on West 35th Street. After years when official response to the epidemic was fragmented, they said, approaches like that at Ali Forney—where HIV is part of the first outreach conversation and stays on the radar throughout a client’s stay, even for those who test negative—are increasingly seen as among the best strategies to finally lower those infection rates.

Siciliano added that last week’s numbers may actually be a sign of progress, indicating that more young people are actually getting tested and getting into care. Still, he cautioned, without an approach such as AF’s, the job is nowhere near done: It takes more than a test, a condom or even a retroviral to address the needs of this vulnerable population.

When knowing didn’t help

When veteran housing activist Siciliano first started working with homeless youth in the 1990s at a Times Square agency called Safe Space, he noticed right away how many were LGBT and prostituting themselves to survive. They were also deeply afraid of being tested for HIV, he said. “Think of it. You’re homeless; every day is chaos. What does knowing you’re HIV-positive do to help you?”

Frustrated with the acute discrepancy between the 5,000–7,000 queer homeless youth in need of shelter each year and the limited number of beds available in the city, Siciliano famously went on to found Ali Forney out of a church basement and a single donation of $37,000, naming it after a former young gay client who had been killed on the streets.

“The day we sent out faxes and e-mails saying we were open,” said Siciliano, “we had 20 youth on a waiting list—and six beds.” Within months, Ali Forney had a real budget and began to operate its first residences; now, with a budget of $4 million, 54 emergency and transitional beds spread across five shelters, two drop-in centers, and partnerships with a score of support organization, AF is justly heralded as a leader in its field. Within the past year, it has been honored as such by Stonewall Democrats, the Empire State Pride Agenda, the Gay and Lesbian Anti-Violence Project, and most recently by The Advocate magazine.

Forney is seen by affiliated groups as the hub of a constellation of shelter services for LGBTQ street youth, which also includes The Door, Sylvia’s Place, Green Windows and Safe Horizon’s Streetworks program. Each works, in its own unique and affiliated way, to address what Siciliano calls an “unforgivable gap” between the adult shelter system, with its court-established right to shelter, and the foster care system. And all, including Forney, have of necessity integrated testing, education, prevention and treatment of HIV in their overall models of service.

Handing out condoms without asking whether you need food

After five years of explosive growth, more than a quarter of Forney’s budget is now a direct result of its approach to HIV. In addition to $1 million from the federal Department of Housing and Urban Development, $800,000 from the New York City Council via the Department of Children and Youth Development, and support from myriad foundations, Ali Forney receives $1.4 million in funds from HUD’s Housing Opportunities for People with AIDS (HOPWA) program. This kind of support, said Siciliano, signifies a sea-change in the institutional response to HIV, which has broadened to address more than medical treatment and research.

Those changes, he added, were borne of necessity as the long-established strategies pioneered earlier in the epidemic proved less successful with the most vulnerable LGBT group in New York: young people living on the streets, often abused and kicked out of their homes, some with never-diagnosed developmental issues.

“Everyone was giving out condoms, but not addressing the fact that these kids were homeless,” said Siciliano of the 1990s. “To have an effective response to young gay men of color, you had to address that many of these young people were homeless and doing survival sex to stay alive.”

Bad numbers equals good news?

This failure, said Siciliano, may be at the root 2006 figures from the New York State Department of Health, which showed that while HIV infection rates had dropped among most groups—IV drug users, women, men over 30 and infants—new diagnoses among under-30 men who have sex with men (MSM) went the other way. Among young black men, new diagnoses went from 168 in 2001 to 232 in 2006; in the same time period, such diagnoses rose among Latinos from 122 to 157 and among whites from 75 to 101.

Staff at Ali Forney are not completely convinced that those figures actually signify an increase in HIV infection. Unlike in 1998, when the Centers for Disease Control and the state DOH reported that 20 percent of young black and Latino MSM were seropositive for HIV but “very few of those youth were getting transitioned into care and treatment,” the figures may instead signify the opposite: that increasingly, young people of color are learning to integrate HIV into their life struggles thanks to the proactive strategies of AF and its sister agencies.

“What I would argue,” said Sicilian, “is that the city’s response has improved and gotten more kids into treatment.”

Talking about testing from the beginning

From the moment Ali Forney’s outreach workers start talking to young people, said Gordon on Tuesday, the subject of HIV is part of the discussion.

Despite recent reports that street youth had “disappeared” from the Meatpacking District, “there are still quite a few at the pier,” said Gordon, a twentysomething young man with bright eyes under his gentle full Afro. “There’s still a stroll.” However, he added, street youth are also increasingly in Bedford-Stuyvesant; Jamaica, Queens; the South Bronx, and downtown Brooklyn’s Fulton Street Mall.

Outreach workers “establish rapport, and start talking about this [drop-in center], what we offer,” said Gordon, and the testing conversation starts there. “They know this is a place they can talk openly about sex, and HIV and...everything!”

Once at the drop-in center, added program director Hartman, clients don’t just fill out a form. “We try to get them seen within an hour of when they arrive. That shows respect, and there are better outcomes that way.”

Meanwhile, for those who do test seropositive for HIV, staff from the Urban Justice Center work to ensure that clients have access to ADAP and Medicaid so that their treatment isn’t interrupted once it starts.

While perhaps 50 percent of Ali Forney clients have already been tested when they arrive, staff cautioned that they need to be re-tested over and over. “There’s a lot of misinformation,” said Hartman. “Like, if you test negative, you absolutely are. Like, the guy I just slept with said he’s negative, so it’s okay. Like, if you’re not wasting away, or if you don’t have KS [Kaposi’s sarcoma] sores on your face, you’re okay.”

Sweeping away such misinformation is thus the talk of numerous rap groups open to all clients and the closed sessions for HIV-positive clients, and of all branches at the agency, its Harlem and Brooklyn apartments, as well as its emergency shelters. This frankness makes clients unafraid to ask questions: One staff member remembered a client who waltzed into the agency’s headquarters and asked, “If a friend of mine had oral sex with an older man ….” That kind of atmosphere, said Hartman, normalizes the whole issue of HIV so that coping with it is a life-skill akin to getting your GED or making dinner.

“They meet with a health educator every week,” said Gordon, and continue that education process in the halls. “As for myself, I’m kind of known as the person to go to with questions about sex and sexuality,” he said, and then blushed slightly at his own words.

Home is a prevention strategy

Far from being discouraged by last week’s splashy figures, Ali Forney’s staff said Tuesday they were energized by the urgency they represented. Siciliano is proud of his agency’s ability “to find kids on the street, get them housed.

“We create the safety and stability, and bring them into an environment where it’s appropriate for them to be tested,” he said, noting that he and the others are acutely aware that, with fewer than 200 beds for homeless LGBTQ youth citywide, there’s still a lot of need yet to be met.

But the director said he was proud of both health officials and the gay community for finally recognizing that supporting homeless LGBTQ youth was not detracting from HIV prevention programs.

“Our holistic approach is an HIV prevention strategy,” said Siciliano. “These kids don’t fit into slots: You have to envelop them with everything you’ve got.”